Comments and Suggestions Form

Please only use this form for comments about the practice and suggestions as to how we can improve our service to you. Medical matters and official complaints cannot be dealt with via this form. If you have a query regarding a medical matter please telephone reception to make an appointment to see the appropriate person.

What kind of comment would you like to send? Remember this form is not for medical
matters.

Your comment is:

A SuggestionPraiseRegarding a ProblemOther

What would you like to say?

Enter your comments in the space below

Your contact details

Your Name:

Your Email:

Your Telephone:

Do you agree to be contacted regarding this matter?

Yes, I agree that the practice may contact me regarding this matter

About This Form

Note that by using this form, you will be sending information about yourself across
the Internet. Whilst every effort is made to keep this information secure, you should
be aware that we cannot offer any guarantees of absolute privacy. If this matter
concerns you then you should use another method to notify us of your comment.

Your IP address (54.146.98.143) will be sent with
your communication. In rare cases where abuse or criminal activity can be shown
to have taken place this may be used by the authorities to trace you.